Based on the history presented, the key points are:
- 56 year old female with history of gastric adenocarcinoma diagnosed 1 year ago
- Underwent 5 cycles of chemotherapy completed in July 2023
- Presented with weakness, nausea, decreased appetite, and abdominal lump for 4 months
- History of hematemesis and melena 2 weeks ago
- Scheduled for restaging CT scan on 10/23/23
Anamnesis
Physical Examination:
General condition: pale, cachectic
T: 36,8 °C
P: 96 x/menit
RR: 20 x/menit
BP: 110/70 mmHg
Weight: 42 kg (
The document lists patients seen at the Emergency Room, Intensive Care Unit, and general wards of a hospital on November 12, 2022 and December 1, 2022. At the ER, 4 new patients were seen on December 1 with conditions including acute heart failure, urinary tract infection, anemia, and possible liver cancer. On November 12, 1 patient had been at the ER for over 24 hours and 2 new patients were admitted to the ICU. The document also lists 1 patient referred from Urology to Nephrology for further evaluation and management of gross hematuria, anemia, and acute kidney injury.
- Patient presented with a 5 day history of dizziness, muscle aching and fever. For the past 4 days, the patient experienced intermittent high fever with chills, headache and weakness.
- Based on history and laboratory findings, the patient was diagnosed with Plasmodium Vivax malaria. The patient had a history of malaria infections and exposure in endemic areas.
- The patient was also diagnosed with acute gastroenteritis. Management involved rehydration, antibiotics and monitoring electrolytes.
- Atrial fibrillation was also noted on examination but with stable hemodynamics. Management focused on risk reduction, stroke prevention and rate control therapy.
A case study on Pangastritis with pancreatitis martinshaji
this case study describes about Pangastritis with pancreatitis , which details about the treatment, management , diagnosis, patient counselling, pharmacist interventions & discussions are followed in this case .
please comment
thank u
martinsuja369@gmail.com
This document provides a morning report on a case of malaria. It summarizes the patient's history, including previous malaria infections, physical examination findings, laboratory test results showing Plasmodium vivax, and diagnosis of malaria tertiana. The patient's treatment plan includes IV fluids, antipyretics, anti-malarial medications, and patient education.
Case study on pangastritis with pancreatitisAnisha Ebens
The patient, a 48-year-old male, presented with abdominal pain and constipation and was diagnosed with pancreatitis and pangastritis based on elevated amylase and lipase levels and findings of gastritis on endoscopy; he was treated in the hospital with IV fluids, antibiotics, proton pump inhibitors, and pain medications. The case highlights potential drug interactions between tramadol/ondansetron and ciprofloxacin/metronidazole that require monitoring or avoidance of concurrent administration.
This document presents a case study of a 47-year-old female patient who presented with fever, nausea, vomiting, and diarrhea for one week along with worsening shortness of breath over the past four days. Her medical history includes diabetes, coronary artery disease, chronic kidney disease, and previous admissions for pyelonephritis and renal calculi. On examination, she had tachycardia, tachypnea, bilateral crackles on lung auscultation, and pedal edema. Investigations revealed a decreased pO2/FiO2 ratio of 242. The patient was started on oxygen supplementation and intravenous norepinephrine.
Management of patient with right upper quadrant pain. (desmoplastic small rou...kr
A 18-year-old male presented with right upper quadrant abdominal pain, nausea, vomiting and fever for the past month. Physical examination revealed hepatomegaly and tenderness in the right upper quadrant. Imaging showed multiple liver lesions and a duodenal mass. Biopsy of the duodenal mass revealed desmoplastic small round cell tumor (DSRCT), a rare and aggressive soft tissue sarcoma.
The document lists patients seen at the Emergency Room, Intensive Care Unit, and general wards of a hospital on November 12, 2022 and December 1, 2022. At the ER, 4 new patients were seen on December 1 with conditions including acute heart failure, urinary tract infection, anemia, and possible liver cancer. On November 12, 1 patient had been at the ER for over 24 hours and 2 new patients were admitted to the ICU. The document also lists 1 patient referred from Urology to Nephrology for further evaluation and management of gross hematuria, anemia, and acute kidney injury.
- Patient presented with a 5 day history of dizziness, muscle aching and fever. For the past 4 days, the patient experienced intermittent high fever with chills, headache and weakness.
- Based on history and laboratory findings, the patient was diagnosed with Plasmodium Vivax malaria. The patient had a history of malaria infections and exposure in endemic areas.
- The patient was also diagnosed with acute gastroenteritis. Management involved rehydration, antibiotics and monitoring electrolytes.
- Atrial fibrillation was also noted on examination but with stable hemodynamics. Management focused on risk reduction, stroke prevention and rate control therapy.
A case study on Pangastritis with pancreatitis martinshaji
this case study describes about Pangastritis with pancreatitis , which details about the treatment, management , diagnosis, patient counselling, pharmacist interventions & discussions are followed in this case .
please comment
thank u
martinsuja369@gmail.com
This document provides a morning report on a case of malaria. It summarizes the patient's history, including previous malaria infections, physical examination findings, laboratory test results showing Plasmodium vivax, and diagnosis of malaria tertiana. The patient's treatment plan includes IV fluids, antipyretics, anti-malarial medications, and patient education.
Case study on pangastritis with pancreatitisAnisha Ebens
The patient, a 48-year-old male, presented with abdominal pain and constipation and was diagnosed with pancreatitis and pangastritis based on elevated amylase and lipase levels and findings of gastritis on endoscopy; he was treated in the hospital with IV fluids, antibiotics, proton pump inhibitors, and pain medications. The case highlights potential drug interactions between tramadol/ondansetron and ciprofloxacin/metronidazole that require monitoring or avoidance of concurrent administration.
This document presents a case study of a 47-year-old female patient who presented with fever, nausea, vomiting, and diarrhea for one week along with worsening shortness of breath over the past four days. Her medical history includes diabetes, coronary artery disease, chronic kidney disease, and previous admissions for pyelonephritis and renal calculi. On examination, she had tachycardia, tachypnea, bilateral crackles on lung auscultation, and pedal edema. Investigations revealed a decreased pO2/FiO2 ratio of 242. The patient was started on oxygen supplementation and intravenous norepinephrine.
Management of patient with right upper quadrant pain. (desmoplastic small rou...kr
A 18-year-old male presented with right upper quadrant abdominal pain, nausea, vomiting and fever for the past month. Physical examination revealed hepatomegaly and tenderness in the right upper quadrant. Imaging showed multiple liver lesions and a duodenal mass. Biopsy of the duodenal mass revealed desmoplastic small round cell tumor (DSRCT), a rare and aggressive soft tissue sarcoma.
This presentation covers gastrointestinal issues, which are commonly experienced by those living with scleroderma. This session is set to be an invaluable resource for patients and caregivers, as it will provide crucial insights and approaches to managing GI issues effectively. Dr. Khanna's vast knowledge and experience make this talk a must-attend event for anyone seeking to enhance their understanding and management of GI symptoms in scleroderma.
This case report describes a 66-year-old obese woman admitted to the hospital for abdominal pain, nausea, vomiting and acute diverticulitis with a suspected colorectal bladder fistula. Over her 8 day hospital stay she received IV antibiotics and underwent diagnostic testing confirming diverticulitis and a colovaginal fistula. Her medical history included multiple conditions related to her obesity. She was seen by a dietitian who provided nutrition counseling and advanced her diet from clear liquids to regular foods before discharge.
The document provides a morning report on a fever of unknown origin case. It summarizes:
1) A 58-year-old male presented with prolonged fever for 1 month despite previous antibiotic treatment for presumed typhoid fever. He had weight loss and decreased appetite.
2) Physical exam was normal but labs showed leukocytosis, increased CRP, and hyponatremia. Imaging found hydronephrosis and nephrolithiasis.
3) Differential diagnoses for the fever of unknown origin were discussed, including further diagnostic tests needed to establish a diagnosis. Control of diabetes and urology follow-up were also mentioned.
CASE PRESENTATION ON DRUG INDUCED GASTROINTESTINAL BLEED.pptxSiddiquaParveen
An 87-year-old male was admitted to the internal medicine department with chief complaints of black vomit and stool over the past few days along with weakness. His medical history included hypertension treated with telma and ecosprin, diabetes treated with janumet, and a hip replacement. Investigation revealed a gastrointestinal bleed likely caused by long-term use of ecosprin, hypertensive encephalopathy, UTI caused by ESBL-negative E. coli, acute kidney injury, and hypokalemia. Treatment included antibiotics, potassium supplementation, blood pressure control, and endoscopy.
This document outlines 6 clinical themes that will be covered in a 4-week kidney module, including patients presenting with painful hematuria, generalized edema, difficulty passing urine, oliguria, rising serum creatinine, and renal transplant. Each theme includes an associated clinical case, objectives, and critical thinking questions to guide student learning through interactive sessions, group discussions, and practical skills.
- The patient, a 48-year-old housewife, presented with nausea, vomiting, loss of appetite, and 7 kg weight loss in the past month with a history of similar symptoms one month ago.
- She was diagnosed with dyspepsia and is being treated with soft food, IV fluids, and omeprazole to eliminate her symptoms while undergoing endoscopy to determine the cause of her dyspepsia.
- The goals are to relieve her current symptoms, identify the cause of her dyspepsia, and prevent future recurrent symptoms and complications through treatment and lifestyle changes.
Chronic Kidney Disease Nursing case presentationChinmayi24
Mr. Bheem Prakash, a 36-year old male with chronic kidney disease (CKD) stage 5 and hypertension, was admitted with complaints of abdominal pain, vomiting, fever and swelling. He has a history of CKD for 2 years and has been undergoing hemodialysis for 1 year. His diagnostic workup confirmed CKD stage 5. His medical management focuses on controlling blood pressure and slowing disease progression through diet, medication and hemodialysis. Nursing care involves monitoring his condition, educating him on self-care, and managing symptoms to improve his quality of life.
Morning Report Thursday, February 1st 2024.pptxTezarAndrean1
The morning report summarizes 3 patients scheduled for procedures. The first is a 4 year old boy scheduled for a brain evoked response auditory procedure for delayed speech. The second is a 12 year old boy with transposition of the great arteries scheduled for tracheostomy and stenosis release for impending airway obstruction. The third is a 58 year old man scheduled for diagnostic laryngoscopy and T-tube placement for subglottic stenosis.
This case study describes a 57-year-old male admitted to the hospital with nausea, vomiting, abdominal pain, jaundice, ascites, and black stools. He was diagnosed with GERD, gastrointestinal bleeding, and cirrhosis. During his hospital stay, he received various treatments including tube feeding and TPN. His condition deteriorated and he was transferred to the ICU. He later stabilized and was transitioned to an oral diet to prepare for discharge with diagnoses of chronic cirrhosis, GERD, and esophageal varices.
This document describes the hospital course of a 57-year-old male with end-stage liver disease and a history of alcoholism. He was admitted with gastrointestinal bleeding from esophageal varices caused by cirrhosis. During his hospital stay, he developed worsening encephalopathy and required placement of a jejunostomy tube and later total parenteral nutrition (TPN) using Hepatamine. His condition stabilized and he was discharged on a soft diet with nutrition counseling and follow up.
Preventable ICU admissions at community level - Interactive CasesVitrag Shah
This document discusses 10 interactive case studies presented by Dr. Vitrag Shah on preventing ICU admissions at the community level. Each case outlines a patient's medical history and presenting symptoms. Dr. Shah then discusses differential diagnoses, abnormal lab or test findings, additional workup needed, and how the situation could have been prevented. The goal is to recognize issues early and optimize treatment to avoid ICU admissions. Key lessons include monitoring for drug side effects, holding certain medications in acute illnesses, considering secondary causes, and screening high-risk patients proactively.
1. The patient is exhibiting signs and symptoms consistent with Kawasaki disease, including prolonged fever, oral ulcers, conjunctivitis, rash, lymphadenopathy, and extremity changes.
2. Kawasaki disease does occur in Egypt, with an estimated 280 cases diagnosed annually.
3. Treatment for Kawasaki disease involves intravenous immunoglobulin and aspirin to prevent coronary artery aneurysms, which develop in around 25% of untreated patients.
- The document describes a case of acute paraquat poisoning in a 45-year-old female patient who was admitted to the hospital with multiorgan failure. She had a history of accidental exposure to paraquat and developed vomiting, hematemesis, jaundice, and respiratory failure. She was managed supportively but ultimately left against medical advice due to poor prognosis. Paraquat poisoning causes oxidative damage leading to injury of lungs, kidneys, liver and other organs. Management involves decontamination, supportive care and dialysis or ventilation as needed, but outcomes are generally poor.
The document presents a case study of a 4-year-old boy diagnosed with Dengue Hemorrhagic Fever grade 3. It describes the patient's family profile, medical history, symptoms, lab results, and treatment over his 7 day hospitalization. Key findings include fever, vomiting, abdominal pain, thrombocytopenia, and signs of plasma leakage. The patient was treated with IV fluids, antibiotics, and supportive care. He recovered well and was discharged once afebrile with improving appetite and stable platelet count above 50,000/mm3.
This document presents 4 case studies of patients with systemic lupus erythematosus (SLE). The first case involves a 32-year-old female who presented with fever, oral ulcers, loose stools, body pains, and swelling. Tests revealed pancytopenia, serositis, and positive ANA and anti-dsDNA antibodies, leading to an SLE diagnosis. The second and third cases provide brief summaries of additional SLE patients, including a 48-year-old female with lupus nephritis and a 25-year-old with transverse myelitis. The fourth case involves a 31-year-old female who presented with fever, malar rash, and headache.
Mrs. Kamrunessa Begum, a 79-year-old female, presented with respiratory distress and right lower abdominal pain. Imaging revealed pulmonary embolism and risk assessments stratified her as moderate risk. She was treated with low molecular weight heparin, antibiotics, non-invasive ventilation, anticoagulation, and physiotherapy. Her condition gradually improved and she was discharged 10 days after admission.
CASE STUDY ON CHRONIC KIDNEY DISEASE.pptxdrsriram2001
Chronic Kidney Disease (CKD) is a progressive condition characterized by the gradual loss of kidney function over time. Here's a comprehensive explanation of CKD in four steps:
Causes and Risk Factors: CKD can result from various underlying conditions or risk factors that damage the kidneys' filtering units (nephrons) and impair their function. Common causes and risk factors include:
Diabetes: High blood sugar levels over time can damage the blood vessels in the kidneys.
Hypertension (high blood pressure): Elevated blood pressure can strain the kidneys' blood vessels and impair kidney function.
Glomerulonephritis: Inflammation of the kidney's filtering units can lead to scarring and loss of function.
Polycystic kidney disease: Inherited disorder characterized by the growth of cysts in the kidneys, leading to kidney enlargement and loss of function.
Prolonged obstruction of the urinary tract: Conditions such as kidney stones or an enlarged prostate can obstruct urine flow, leading to kidney damage.
Autoimmune diseases: Conditions like lupus or vasculitis can cause inflammation and damage to the kidneys.
Certain medications: Long-term use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or some antibiotics, can contribute to kidney damage.
Stages and Progression: CKD is typically classified into five stages based on the estimated glomerular filtration rate (eGFR), which measures how well the kidneys are filtering waste from the blood. The stages are as follows:
Stage 1: Kidney damage with normal or high eGFR (≥90 mL/min/1.73 m²)
Stage 2: Mild decrease in eGFR (60-89 mL/min/1.73 m²)
Stage 3: Moderate decrease in eGFR (30-59 mL/min/1.73 m²)
Stage 4: Severe decrease in eGFR (15-29 mL/min/1.73 m²)
Stage 5: Kidney failure (eGFR <15 mL/min/1.73 m² or dialysis)
CKD progresses slowly over time, and symptoms may not be apparent until the later stages when significant kidney damage has occurred.
Symptoms and Complications: In the early stages, CKD may be asymptomatic, and symptoms may only become evident as kidney function declines. Common symptoms and complications of CKD include:
Fatigue and weakness
Swelling of the legs, ankles, or feet (edema)
Shortness of breath
Nausea and vomiting
Itching
Loss of appetite
Muscle cramps
Difficulty concentrating
Electrolyte imbalances (e.g., high potassium levels)
Bone disease (e.g., osteoporosis)
Anemia
Complications of advanced CKD include cardiovascular disease, fluid overload, electrolyte imbalances, and kidney failure requiring dialysis or kidney transplantation.
Management and Treatment: The management of CKD aims to slow the progression of the disease, manage symptoms, and prevent complications. Treatment may involve:
Lifestyle modifications: Maintaining a healthy diet low in salt, potassium, and phosphorus, exercising regularly, maintaining a healthy weight, and quitting smoking.
Blood pressure control: Medications such as ACE inhibitors
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
This presentation covers gastrointestinal issues, which are commonly experienced by those living with scleroderma. This session is set to be an invaluable resource for patients and caregivers, as it will provide crucial insights and approaches to managing GI issues effectively. Dr. Khanna's vast knowledge and experience make this talk a must-attend event for anyone seeking to enhance their understanding and management of GI symptoms in scleroderma.
This case report describes a 66-year-old obese woman admitted to the hospital for abdominal pain, nausea, vomiting and acute diverticulitis with a suspected colorectal bladder fistula. Over her 8 day hospital stay she received IV antibiotics and underwent diagnostic testing confirming diverticulitis and a colovaginal fistula. Her medical history included multiple conditions related to her obesity. She was seen by a dietitian who provided nutrition counseling and advanced her diet from clear liquids to regular foods before discharge.
The document provides a morning report on a fever of unknown origin case. It summarizes:
1) A 58-year-old male presented with prolonged fever for 1 month despite previous antibiotic treatment for presumed typhoid fever. He had weight loss and decreased appetite.
2) Physical exam was normal but labs showed leukocytosis, increased CRP, and hyponatremia. Imaging found hydronephrosis and nephrolithiasis.
3) Differential diagnoses for the fever of unknown origin were discussed, including further diagnostic tests needed to establish a diagnosis. Control of diabetes and urology follow-up were also mentioned.
CASE PRESENTATION ON DRUG INDUCED GASTROINTESTINAL BLEED.pptxSiddiquaParveen
An 87-year-old male was admitted to the internal medicine department with chief complaints of black vomit and stool over the past few days along with weakness. His medical history included hypertension treated with telma and ecosprin, diabetes treated with janumet, and a hip replacement. Investigation revealed a gastrointestinal bleed likely caused by long-term use of ecosprin, hypertensive encephalopathy, UTI caused by ESBL-negative E. coli, acute kidney injury, and hypokalemia. Treatment included antibiotics, potassium supplementation, blood pressure control, and endoscopy.
This document outlines 6 clinical themes that will be covered in a 4-week kidney module, including patients presenting with painful hematuria, generalized edema, difficulty passing urine, oliguria, rising serum creatinine, and renal transplant. Each theme includes an associated clinical case, objectives, and critical thinking questions to guide student learning through interactive sessions, group discussions, and practical skills.
- The patient, a 48-year-old housewife, presented with nausea, vomiting, loss of appetite, and 7 kg weight loss in the past month with a history of similar symptoms one month ago.
- She was diagnosed with dyspepsia and is being treated with soft food, IV fluids, and omeprazole to eliminate her symptoms while undergoing endoscopy to determine the cause of her dyspepsia.
- The goals are to relieve her current symptoms, identify the cause of her dyspepsia, and prevent future recurrent symptoms and complications through treatment and lifestyle changes.
Chronic Kidney Disease Nursing case presentationChinmayi24
Mr. Bheem Prakash, a 36-year old male with chronic kidney disease (CKD) stage 5 and hypertension, was admitted with complaints of abdominal pain, vomiting, fever and swelling. He has a history of CKD for 2 years and has been undergoing hemodialysis for 1 year. His diagnostic workup confirmed CKD stage 5. His medical management focuses on controlling blood pressure and slowing disease progression through diet, medication and hemodialysis. Nursing care involves monitoring his condition, educating him on self-care, and managing symptoms to improve his quality of life.
Morning Report Thursday, February 1st 2024.pptxTezarAndrean1
The morning report summarizes 3 patients scheduled for procedures. The first is a 4 year old boy scheduled for a brain evoked response auditory procedure for delayed speech. The second is a 12 year old boy with transposition of the great arteries scheduled for tracheostomy and stenosis release for impending airway obstruction. The third is a 58 year old man scheduled for diagnostic laryngoscopy and T-tube placement for subglottic stenosis.
This case study describes a 57-year-old male admitted to the hospital with nausea, vomiting, abdominal pain, jaundice, ascites, and black stools. He was diagnosed with GERD, gastrointestinal bleeding, and cirrhosis. During his hospital stay, he received various treatments including tube feeding and TPN. His condition deteriorated and he was transferred to the ICU. He later stabilized and was transitioned to an oral diet to prepare for discharge with diagnoses of chronic cirrhosis, GERD, and esophageal varices.
This document describes the hospital course of a 57-year-old male with end-stage liver disease and a history of alcoholism. He was admitted with gastrointestinal bleeding from esophageal varices caused by cirrhosis. During his hospital stay, he developed worsening encephalopathy and required placement of a jejunostomy tube and later total parenteral nutrition (TPN) using Hepatamine. His condition stabilized and he was discharged on a soft diet with nutrition counseling and follow up.
Preventable ICU admissions at community level - Interactive CasesVitrag Shah
This document discusses 10 interactive case studies presented by Dr. Vitrag Shah on preventing ICU admissions at the community level. Each case outlines a patient's medical history and presenting symptoms. Dr. Shah then discusses differential diagnoses, abnormal lab or test findings, additional workup needed, and how the situation could have been prevented. The goal is to recognize issues early and optimize treatment to avoid ICU admissions. Key lessons include monitoring for drug side effects, holding certain medications in acute illnesses, considering secondary causes, and screening high-risk patients proactively.
1. The patient is exhibiting signs and symptoms consistent with Kawasaki disease, including prolonged fever, oral ulcers, conjunctivitis, rash, lymphadenopathy, and extremity changes.
2. Kawasaki disease does occur in Egypt, with an estimated 280 cases diagnosed annually.
3. Treatment for Kawasaki disease involves intravenous immunoglobulin and aspirin to prevent coronary artery aneurysms, which develop in around 25% of untreated patients.
- The document describes a case of acute paraquat poisoning in a 45-year-old female patient who was admitted to the hospital with multiorgan failure. She had a history of accidental exposure to paraquat and developed vomiting, hematemesis, jaundice, and respiratory failure. She was managed supportively but ultimately left against medical advice due to poor prognosis. Paraquat poisoning causes oxidative damage leading to injury of lungs, kidneys, liver and other organs. Management involves decontamination, supportive care and dialysis or ventilation as needed, but outcomes are generally poor.
The document presents a case study of a 4-year-old boy diagnosed with Dengue Hemorrhagic Fever grade 3. It describes the patient's family profile, medical history, symptoms, lab results, and treatment over his 7 day hospitalization. Key findings include fever, vomiting, abdominal pain, thrombocytopenia, and signs of plasma leakage. The patient was treated with IV fluids, antibiotics, and supportive care. He recovered well and was discharged once afebrile with improving appetite and stable platelet count above 50,000/mm3.
This document presents 4 case studies of patients with systemic lupus erythematosus (SLE). The first case involves a 32-year-old female who presented with fever, oral ulcers, loose stools, body pains, and swelling. Tests revealed pancytopenia, serositis, and positive ANA and anti-dsDNA antibodies, leading to an SLE diagnosis. The second and third cases provide brief summaries of additional SLE patients, including a 48-year-old female with lupus nephritis and a 25-year-old with transverse myelitis. The fourth case involves a 31-year-old female who presented with fever, malar rash, and headache.
Mrs. Kamrunessa Begum, a 79-year-old female, presented with respiratory distress and right lower abdominal pain. Imaging revealed pulmonary embolism and risk assessments stratified her as moderate risk. She was treated with low molecular weight heparin, antibiotics, non-invasive ventilation, anticoagulation, and physiotherapy. Her condition gradually improved and she was discharged 10 days after admission.
CASE STUDY ON CHRONIC KIDNEY DISEASE.pptxdrsriram2001
Chronic Kidney Disease (CKD) is a progressive condition characterized by the gradual loss of kidney function over time. Here's a comprehensive explanation of CKD in four steps:
Causes and Risk Factors: CKD can result from various underlying conditions or risk factors that damage the kidneys' filtering units (nephrons) and impair their function. Common causes and risk factors include:
Diabetes: High blood sugar levels over time can damage the blood vessels in the kidneys.
Hypertension (high blood pressure): Elevated blood pressure can strain the kidneys' blood vessels and impair kidney function.
Glomerulonephritis: Inflammation of the kidney's filtering units can lead to scarring and loss of function.
Polycystic kidney disease: Inherited disorder characterized by the growth of cysts in the kidneys, leading to kidney enlargement and loss of function.
Prolonged obstruction of the urinary tract: Conditions such as kidney stones or an enlarged prostate can obstruct urine flow, leading to kidney damage.
Autoimmune diseases: Conditions like lupus or vasculitis can cause inflammation and damage to the kidneys.
Certain medications: Long-term use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or some antibiotics, can contribute to kidney damage.
Stages and Progression: CKD is typically classified into five stages based on the estimated glomerular filtration rate (eGFR), which measures how well the kidneys are filtering waste from the blood. The stages are as follows:
Stage 1: Kidney damage with normal or high eGFR (≥90 mL/min/1.73 m²)
Stage 2: Mild decrease in eGFR (60-89 mL/min/1.73 m²)
Stage 3: Moderate decrease in eGFR (30-59 mL/min/1.73 m²)
Stage 4: Severe decrease in eGFR (15-29 mL/min/1.73 m²)
Stage 5: Kidney failure (eGFR <15 mL/min/1.73 m² or dialysis)
CKD progresses slowly over time, and symptoms may not be apparent until the later stages when significant kidney damage has occurred.
Symptoms and Complications: In the early stages, CKD may be asymptomatic, and symptoms may only become evident as kidney function declines. Common symptoms and complications of CKD include:
Fatigue and weakness
Swelling of the legs, ankles, or feet (edema)
Shortness of breath
Nausea and vomiting
Itching
Loss of appetite
Muscle cramps
Difficulty concentrating
Electrolyte imbalances (e.g., high potassium levels)
Bone disease (e.g., osteoporosis)
Anemia
Complications of advanced CKD include cardiovascular disease, fluid overload, electrolyte imbalances, and kidney failure requiring dialysis or kidney transplantation.
Management and Treatment: The management of CKD aims to slow the progression of the disease, manage symptoms, and prevent complications. Treatment may involve:
Lifestyle modifications: Maintaining a healthy diet low in salt, potassium, and phosphorus, exercising regularly, maintaining a healthy weight, and quitting smoking.
Blood pressure control: Medications such as ACE inhibitors
Similar to 20231019_Ca_gaster_post_kemoterapi_metastase_hepar,_Anemia_dr_Ninis.pptx (20)
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
1. MORNING REPORT
October 19th, 2023
PPDS-1 Ilmu Penyakit Dalam - Fakultas Kedokteran Universitas Lambung Mangkurat/ RSUD Ulin Banjarmasin
2. VISI
PROGRAM STUDI PENDIDIKAN DOKTER SPESIALIS ILMU PENYAKIT DALAM
FAKULTAS KEDOKTERAN UNIVERSITAS LAMBUNG MANGKURAT
Menjadi Institusi Program Pendidikan Dokter Spesialis
Penyakit Dalam yang unggul dan berdaya saing nasional,
dalam menyelenggarakan Tri Dharma perguruan tinggi
dengan mengembangkan IPTEKDOK khususnya berwawasan
penyakit di lingkungan lahan basah.
PPDS-1 Ilmu Penyakit Dalam - Fakultas Kedokteran Universitas Lambung Mangkurat/ RSUD Ulin Banjarmasin
3. MISI
PROGRAM STUDI PENDIDIKAN DOKTER SPESIALIS ILMU PENYAKIT DALAM
FAKULTAS KEDOKTERAN UNIVERSITAS LAMBUNG MANGKURAT
1. Menyelenggarakan program pendidikan dokter spesialis Penyakit Dalam yang menghasilkan SDM
berkualitas sebagai pendukung pembangunan nasional terutama permasalahan kesehatan berwawasan
penyakit di lingkungan lahan basah
2. Menyelenggarakan penelitian yang menghasilkan IPTEKDOK sesuai dengan kebutuhan prioritas
pembangunan nasional terutama permasalahan kesehatan berwawasan penyakit di lingkungan lahan
basah.
3. Menyelenggarakan pengabdian kepada masyarakat dan menyebarluaskan IPTEKDOK untuk
meningkatkan kualitas hidup masyarakat terutama permasalahan kesehatan berwawasan penyakit di
lingkungan lahan basah.
4. Memantapkan kerjasama dengan pemerintah daerah diwilayah Kalimantan, perguruan tinggi dalam dan
luar negeri, pengusaha dan para pihak lainnya untuk peningkatan pelaksanaan Tridharma Perguruan
Tinggi dan Pengadaan sumber dana (Income generating).
5. Meningkatkan transparansi dan akuntabilitas dalam manajemen pengelolaan Program Pendidikan Dokter
Spesialis Penyakit Dalam
PPDS-1 Ilmu Penyakit Dalam - Fakultas Kedokteran Universitas Lambung Mangkurat/ RSUD Ulin Banjarmasin
4. MORNING REPORT
Wednesday, October 19th 2023
MR Facilitator : dr. Sigit Prasetia Kurniawan, SpPD, K-HOM, FINASIM
Co-Facilitator I : dr. Nurul Aina, SpPD, FINASIM
Co-Facilitator II : dr. Lingga Suryakusumah, SpPD
Supervisor on Duty : dr. Diah Sukmawati Hidayah, MMR, SpPD
Duty Team
Chief/III : dr. Adlan
R6 : dr. Rudex
R5 : dr. Anna
IIB : dr. Ninis, dr. Coni
IIA : dr. Topan
IB : dr. Kevin, dr. Fadil
IA : dr. Syaidy, dr. Alex
PPDS-1 Ilmu Penyakit Dalam - Fakultas Kedokteran Universitas Lambung Mangkurat/ RSUD Ulin Banjarmasin
5. ER PATIENTS
PPDS-1 Ilmu Penyakit Dalam - Fakultas Kedokteran Universitas Lambung Mangkurat/ RSUD Ulin Banjarmasin
6. No Name/Age Diagnosis Info
1. Mr. R/48 yo
Severe Anemia, Hematemesis Melena, Hypoalbuminemia,
Hyponatremia
Tulip lt. 3
2. Mrs. T/56 yo
Severe Anemia, Adenocarcinoma gaster metastase liver,
Pulmonary nodule, AKI, Esophagitis
Tulip lt. 3
3. Mr. AS/83 yo
Acute Gout, ACKD, TB on treatment, Hypoalbumin, Prostate
hyperplasia
Mawar 2b
4. Mr. A/65 yo ACKD, Anemia, Chronic cough, hyperuricemia, Ht. st.2 Mawar 2a
5. Mr. Is/62 yo
Severe Anemia, CKD st. 5 on HD, HT, Polycystic kidney
disease
Tulip lt.3
6. Mrs. TY/38 yo
DoC, severe Anemia, Melena, CKD st. 5 on HD, HT
Tulip lt.3
7. Mr. JH/58 yo
DoC, HCC CTP C BCLD D, with cancer pain, Melena, AKI,
Hyperkalemia
ER
New Patient at ER (12/01/2022)
New Patient at ER (18/10/2023)
7. No Name/Age Diagnosis Info
1. Mr. JH/58 yo
DoC, HCC CTP C BCLD D, with cancer pain, Melena, AKI,
Hyperkalemia
Consult to
Nephrologist
Stagnant at ER < 24h (18/10/2023)
11. No Name/Age Diagnosis Info
1. Mr. Ef/66 yo
Syok Cardiogenic, Melena non variceal, Anorexia Geriatric,
AKI dd ACKD, HF, OMI, Geriatric Problem
From Mawar
New Patients at ICCU (18/10/2023)
12. No
Identity
(Name/Age/MR/
Department)
Problem Diagnosed Answered
1. Mrs. RS/ 42 yo/
RMK 01532470
Leukopenia
treatment, upgrade
LFT, HT stage 2, Ca
cervix stage 3B susp
pulmo metastasis
post chemotherapy
5x
1. Leukopenia with neutropenia
1.1 chemotherapy induced
(paclitaxel, carboplatin)
1.2 Bone marrow infiltration
2. Ca cervix stadium 3B dg pulmo
metastasis on chemotherapy
3. Elevated liver enzyme
3.1 metastasis?
3.2 reactive rt chemotherapy
induced
4. HT on normotension
Therapy
• Diet TKTP 1600 kkal
• RG < 5 gram/day
• Leucogen, same as Ts DPJP
• Po Curcuma 3x1 caps
• Indication and chemotherapy eligibility
from TS DPJP
Plan IPD:
• Evaluate SGOT/SGPT 72 hours later
• USG Abdomen
• We do not join care this patient
Consult To IPD ( 18/10/2023)
13. No
Identity
(Name/Age/MR/
Department)
Problem Diagnosed Answered
2. Mrs. FE/59 yo/
RMK 01534478
Treatment 1. AIHA warm type with severe Anemia
Makrositer
2. T inverted lead I,II,AVL,V1
2.1 normal variant
2.2 related anemia
3. Low Back Pain dt Fraktur
Compression VL1-L2 +
Spondylolisthesis VL5-S1 Asia
Impairment Scale E
4. Ulkus decubitus grade 1
5. Colitis improved
Acc change leader
Therapy:
• Soft diet TKTP 1500 kkal/day
• PRC transfusion (8-7.2)× 4 × 50= 160
cc,1 kolf PRC Leukodepleted
IV
• IVFD NaCl 0.9% 1500 cc/24 hours
• Inj. Methylprednisolone 62.5mg/12
hours
• Inj. Omeprazole 40mg/24 hours
Po
• Po Imuran (Azathioprine) 2x50mg
Plan:
• Check DR post correction
• Aware of transfusion reaction
• Repeat EKG post transfusion
• Compress decubitus wound
• Join care with HOM division at ward
Consult To IPD ( 18/10/2023)
14. No
Identity
(Name/Age/MR/
Department)
Problem Diagnosed Answered
3. Mrs. S/54 yo/
RMK 01536742
AKI Treatment 1. Rentensio Urine + Hydronephrosis
bilateral Dt obstructive uropathy
2. AKI stage III dd ACKD
Acute insult : volume depletion
Chronic insult : PNC
3. Severe Hypoalbumin
4. Ischemic anterior + Prolonged QT
4.1 ACS
4.2 CCS
5. Non Keratizing Squamous Cell
Carcinoma Cervix
• Avoid nephrotoxic drugs
• Monitor urine output and equal fluid
balance everyday
• Check UL
• Check Ureum/Creatinin per 48 hours
Saran:
• Transfusion albumin 20% 100cc
• Stop antrain
• Co Cardiology
• Join care with nephrology division IPD
Consult To IPD ( 18/10/2023)
15. WARD PATIENTS
TEAM PATIENTS
PDP 23
PDW 22
ISO/TB 0/0
PPDS-1 Ilmu Penyakit Dalam - Fakultas Kedokteran Universitas Lambung Mangkurat/ RSUD Ulin Banjarmasin
16. No Name/Age Diagnosis Info
1. Mr. R/ 26 yo
Hyperleukocytosis with Low Risk TLS, Anemia NN,
Hepatosplenomegaly, Thrombocytosis, Asymptomatic
Hyperuricemia, Hypokalemia
Polyclinic HOM
2. Mrs. N/ 54 yo
CLL RAI 1 BINET A, Neutropenia without Febrile,
Thrombocytopenia
Polyclinic HOM
3. Mrs. E/ 24 yo
AFI Day 7, Leukopenia, Coated Tongue dt Thypoid Fever dd Dengue
fever, Other viral infection, hypokalemia
From ER
4. Mrs. WB / 30 yo
Adenocarcinoma colon with cancer pain, Febrile neutropenia, SLE
with mild disease activity, Multiple Colon Polyposis, T inverted
without chest pain on V1
From ER
5. Mrs. F/ 62 yo DOC, SOB, AKI st 3 dd ACKD stge V newly diagnostic, HT, HNP
From Alamanda,
Passed away 18.52
6. Mr. RE/48 yo
Anemia MH, Hematemesis Melena (Non variceal Bleeding), Mild
hyponatremia hypoosmolar euvolemia
From ER
7. Mrs.T /57 yo
Anemia NN, Adenocarcinoma gaster st IV, Pulmonary Nodule rt
Metastasis Process T3bN2M13. AKI stage 4, Esofagitis LA grd B,
Asymptomatic moderate hyponatremia hipoosmolar hypovolemia,
Cancer Cachexia
Polyclinic
8. Mr. I/62 yo
Anemia MH, CKD stg 5 on HD (1x per minggu) HT. Polycystic
Kidney Disease
From ER
New Patients at WARD (18/10/2023)
17. No Name/Age Diagnosis Info
1. - - -
2.
3.
4.
5.
6.
7.
8.
Dead Patients at WARD (18/10/2023)
18. No Name/Age Diagnosis Info
1. Mrs. F / 62 yo
DOC, AKI st 3 dd ACKD stge V newly, Anemia NN,
HT, HNP
Dead at18.52 WITA
2. Mr. K/51 yo
COC, Syok sepsis Qsofa 3 with SOI DFU Wagner,
DOC dt hipoglikemik, anemia MH, DM tipe 2, DFU
Wagner 4 pedis dextra, Wagner 2 maleolus sinistra,
HT, Hiponatremia hipoosmolar euvolume, Severe
hypoalbuminemia Malnutrisi11. Deformitas of upper
ekstremitas dextra dt trauma.
Dead at 02.05
Dead Patients at WARD (18/10/2023)
19. CASE PRESENTATION
Mrs. T/ 56 YO
PPDS-1 Ilmu Penyakit Dalam - Fakultas Kedokteran Universitas Lambung Mangkurat / RSUD Ulin Banjarmasin
20. • Name/Age : Mrs. T/ 56 y.o
• Birth of date : 3th June 1966
• Medical Record : 01513257
• Occupation : Housewife
• Marital status : Had Married
• Last Education : Senior High School
• Adresses : Brigend Hasan Basry gg Rahim 2
Identity
21. Identity : Mrs. T / 56 y.o
Chief complaint : Weakness
HISTORY OF PRESENT ILLNESS :
• Patient came to the emergency room with complaint of weakness since 1
week ago. complaint did not improve with rest, food cannot enter. The
patient looks pale.
• Patient also had nausea and vomited 1 time per day, also complaint of
decreased appetite.
• 1 year ago patient complained about decreased of appetite for 1 month,
nausea, and black tarry stools, and went to RS Islam for treatment, and
went to RS Ulin for diagnosis and treatment. The patient was diagnosed
with tumor in the stomach based on endoscopy and the biopsy result in
Adenocarcinoma gaster and has chemotherapy for 5 times.
• Patient felt a hard lump on the right side of her stomach that has been
getting bigger since 4 months ago, getting bigger since 2 weeks ago.
She also complained of heartburn. Complaint of abdominal pain was
Anamnesis
22. • History of black stools and black vomit 2 weeks ago, but now there are no
black stools or black vomit
• History of Gastric cancer with liver metastases by digestive surgery planned
surgery but refused by patient
• The patient complained about the decrease in her appetite because her
stomach felt full quickly.
• Urination decreased 2 times/day, approximately 300cc/24 hours, pain
when urinate (-), blood (-)
• History of first chemotherapy in March 2023 with a regimen of cisplatin, 5
FU, and leucovurin completed in 6 cycles in July 2023.
• No complaints about urination, frequency 4-5 times, normal amount. Pain
when urination was denied.
• History of repeated transfusions since the start of chemotherapy due to
anemia, most recently last month 6 bags of red blood transfusion.
• Patient was scheduled for a contrast abdominal CT scan on 10/23/23 due
to restaging post-first chemotherapy
• Hypertension was denied, Diabetes mellitus was denied
Anamnesis
23. HISTORY OF PAST ILLNESS
Liver disease (-), kidney disease (-), Heart disease (-), Stroke (-), Tuberculosis (-)
HISTORY OF MEDICATION
The first chemotherapy was in March 2023 with a regimen of cisplatin, 5 FU, and
leucovorin completed in 6 cycles in July 2023
FAMILY MEDICAL HISTORY
HT (-), DM (-), Malignancy (-), heart disease (-), kidney disease(-)
PERSONAL AND SOCIAL HISTORY
- Patient did not have history of consuming alcohol
- Patient did not have history of herbal
- Patient did not have history of drug abuse
Anamnesis
24. Physical Examination
General appearance: looked moderate ill
GCS : E4 V5 M6
Weight : 42 Kg
Height : 155 Cm
BMI : 17.5 (Underweight)
UOP : 500 cc/24 hours
Diuresis : 0.4 cc/kgBB/hours
VAS 5
BP: 110/80mmHg
HR: 109 bpm 98
bpm
RR: 20 bpm Tax: 36.3 oC SpO2: 98 on RA
Head
Eye
Mouth
Tongue
Etc
: Pale conjunctiva (+/+), sclera icteric (-), palpebra oedema (-), moon face (-)
: Pale (-), cyanosis (-), dry mucosa (-), ulcer (-)
: Papilla atrophy (-)
: Atrophy M. Temporalis (-), hair loss (-), Moon face (-), buffalo hump (-)
Neck
JVP
Lymph node
Thyroid
: 5+2 cm H2O, hepatojugular reflux (-)
: Lymph node enlargement (-)
: mass (-), bruit (-), pain (-/-)
Axilla : Lymph node enlargement (-)
Thorax Heart
Inspection
Palpation
Percussion
Auscultation
: Ictus cordis seen
: Ictus palpable at ICS V midclavicula line sinistra, thrill (-)
: LMH (Left Margin of Heart) ictus cordis at ICS V midclavicularis line sinistra
: RHM (Right Margin of Heart) : sternalis line dextra
ICS II Parasternalis line dextra: aortic valve murmur (-)
ICS II Parasternalis line sinistra: pulmonal valve murmur (-)
ICS IV-V Parasternalis line sinistra: tricuspid valve murmur (-)
ICS IV-V midclavicularis line sinistra: mitral valve murmur (-)
25. Thorax
Lung
(Anterior)
Inspection: symmetrical thoracal expansion, intercostal retraction (-)
Vocal
Fremitus
Percussion Breath Sound Ronchi Wheezing Egophony
D = S Sonor Sonor Vesicular Vesicular - - - - - -
D = S Sonor Sonor Vesicular Vesicular - - - - - -
D = S Sonor Sonor Vesicular Vesicular - - - - - -
D = S Sonor Sonor Vesicular Vesicular - - - - - -
D = S Sonor Sonor Vesicular Vesicular - - - - - -
D = S Sonor Sonor Vesicular Vesicular - - - - - -
Physical Examination
26. Physical Examination
Thorax
Lung
(Posterior)
Inspection: symmetrical thoracal expansion, intercostal retraction (-)
Vocal
Fremitus
Percussion Breath Sound Ronchi Wheezing Egophony
D = S sonor sonor Vesicular Vesicular - - - - - -
D = S sonor sonor Vesicular Vesicular - - - - - -
D = S sonor sonor Vesicular Vesicular - - - - - -
D = S sonor sonor Vesicular Vesicular - - - - - -
D = S sonor sonor Vesicular Vesicular - - - - - -
D = S sonor sonor Vesicular Vesicular - - - - - -
D = S sonor sonor Vesicular Vesicular - - - - - -
27. Abdomen
Inspection : Soefl (+), striae (+), venectation (-), protrude umbilicus (-), no pulsation was seen.
Auscultation : Bowel sounds (+) 10 bpminute, other sounds (-)
Percussion : tympanic sound Inferior border of right rib --> dullness (liver)
Inferior border of left rib -> tympani (gastric)
Traube space timpani
Palpation : Abdominal tenderness (+) epigastric
Defensive muscular (-)
Superficial mass (-)
Intra-abdominal mass (-)
The patient's face doesn’t look painful when the abdomen is palpated
Blast (-)
Free fluid examination : Shifting dullness (-)
Right hypochondriacal : mass palpable, humped, hard, immobile, uk. 7x7 cm
Liver palpation : not palpable liver
Palpation of the spleen : Schuffner method: spleen difficult to evaluate
Palpation of McBurney's point: Tenderness (-), pain relief (-), Local muscular defans (-)
Ballotement : Impression was not felt on right/left
CVA tap pain : Right (-/-) left (-/-)
Inguinal Lymphadenopathy (-)
Extremity
Spoon nails (-/-), clubbing fingers (-/-), petechiae (-)
Edema superior (-/-), Oedema inferior ext edema (-/-), pitting edema (-)
CRT < 2”, cold (-/-)
Enlarged lymph nodes (-/-), flapping tremor (-), palmar erythema (-)
Motoric (5/5/5/5), sensorics normal
Rectal
Toucher:
Anal sphincter clamps tightly, rectal ampulla does not collapse, mass (-), blood (-), feces (-), melena (-
)
Physical Examination
32. Identity Mrs. T/ 56 yo
Position PA
Density Enough
Inspiration Enough
Soft Tissue Normal
Bone Intact
Trachea Normal
Hilus D/S Normal
Mediastinum Wide
Cor CTR 48%
Hemidiaphragm Sinistra (normal)
Dextra ( normal)
Costophrenicus
Sinus
Sinistra : sharp
Dextra : sharp
Parenchym Infiltrate (-)
Conclusion Expertise(-)
Opaque nodule with other small opaque nodules around it 7th
intercostal right posterior soft tissue mass
Chest X-ray
A B
A B
C
C
Opaque nodule with other small opaque nodules around it 6th
intercostal right posterior soft tissue mass
34. sinus rhythm Q wave : pathological Q (-)
Regular QRS Complex : 0.08 s, RBBB -, LBBB -
Heart Rate 98 bpm
ST segment : isoelectric, ST elevation (-), ST
depression (-)
Normal Axis T inverted (-) peak tall T (-), U wave (-)
Horizontal Axis: no rotation
R/S <1
R V5/6 + S V1 <56 RVH (-), LVH (-)
P wave : 0.08 s, P mitral (-), P pulmonal (-
)
PR interval : 0.12 s
Conclusion :
Sinus rhytm, 98 bpm, LAE
ECG Interpretations 18/10/2023
35. Endoscopy (05/11/2022 Pre Chemotherapy)
Results
Esophagitis LA grade B
The mass from the lesser
curvature of the corpus to the
gastric antrum is suspiciously
malignant
36. Abdominal CT Scan 06/01/2023 (Pre Kemo)
Results
- Susp gastric mass.
malignancy
- Multiple liver nodules
suggestive of liver
metastases
- No visible enlargement
of the abdominal para
aorta lymph nodes
38. USG Abdominal 02/08/2023 Post Chemotherhapy
Results
There is no obvious gastric mass
No intrahepatal metastases were seen
There was no visible enlargement of the
paraaortic/parailiac lymph nodes
Radiologically, the liver, gallbladder,
spleen, pancreas, bilateral kidneys and
urinary bladder are within normal limits.
39. • Liver size 12 cm, multiple
nodules
USG Bedside
41. 7 months ago
Weight loss
Gastric cancer
with liver
metastases
First
chemotherapy
2 months ago
Mass right
hypochondrium
2 weeks ago
History of Black
stools and black
vomitting
1 week ago
Weakness
Nause
Vomitting
Enlargement
Mass right
hypochondrium
TIMELINE
42. Summary of Database
RESUME OF DATABASE
ANAMNESIS PHYSICAL EXAMINATION OTHER EXAMINATION
• Weaknesses
• Looks pale
• Nausea and vomit,
Heartburn
• History of black vomiting
• Stomach felt full quickly
• Decrease of body weight
• Mass in the abdomen
dextra and the middle of
the stomach
• History of repeated
hospitalization due to
anemia
• Diagnosed with
Adenocarcinoma gaster
• planned abdominal CT
scan for restagging
Objective
KU: looks moderately ill
GCS: E4 V5 M6
BP : 110/80mmHg
Pulse: 98x/menit
RR : 22x/menit
T : 36.3⁰C
SpO2 : 98 % on RA
VAS 5
BW: 42 Kg / TB: 155cm/ IMT: 17.5
(Underweight)
UOP : 500 cc/24 hours
Diuresis : 0.4 cc/kgBB/hours
WHO dehidration score 8 (mild moderate
dehydration)
Head/neck : pale conjunctiva (+)
Abdomen: Distended (-), BS (+), soefl,
tenderness (+) a/r epigastric
Status location a/r right hipocondriaca:
palpable hard mass, diameter 7 cm, uneven
surface, unclear boundaries, mobile,
tenderness (+)
Rectal Toucher: melena (-), blood (-)
Laboratory 18/10/23
Hb 5.1/MCV 95.3/ MCH 29.8
Leukosit 9.300/N% 85.7/L% 7.6
Tromb 451.000/Eritrosit 1.71
RDW 15.7
SGOT 70/ SGPT 37
GDS 108
Ur 45/Cr 1.63
Na 128/K 4.8/ Cl 104
Osm 267 (hipoosmolar)
Laboratorium 4/9/23 RS Ulin
LDH 174
CEA 5.04
EKG 18/10/23
Sinus rhytm, 98 bpm, LAE
Rontgen thorax 18/10/23
Impression:
Opaque nodule with other small
opaque nodules around it 6th
intercostal right posterior soft tissue
mass
Urinalysis 19/10/23
Yellow clear
pH 6.0, Spesific gravity 1.025
Prot +1
Gastric Biopsy Results 07/11/22
Gastric biopsy: Adenocarcinoma
of the stomach
Endoscopy results 05/11/22 Ulin
Hospital
Esophagitis LA grade B
Mass curvatura minor corpus to
gastric antrum suspected
malignant
CT scan abdoment Ulin Hospital
06/1/23
- gastric mass susp. malignancy
- multiple Hepar nodules
suggestive of liver metastases
- no visible KGB enlargement
paraaourta abdominalis
USG abdomen 2/8/23 after
chemotherapy
No obvious gastric mass
No visible intrahepatal
metastases
No visible paraaortic/parailiac
KGB enlargement
Radiologically Hepar, Gallbladder,
Spleen, Pancreas, bilateral Kidney
and Vesica Urinaria within normal
limits.
Regimen kemoterapi March
2023 six cycle
Cisplatin
5FU
leucovurin
43. 1. Severe anemia NN
2. Nausea vomite with mild moderate dehydration
3. AKI stage 1
4. Adenocarcinoma gaster st IV post kemoterapi with cancer
pain
5. Esofagitis LA grd B
6. Asymptomatic moderate hiponatremia hipoosmolar
hipovolemia
PROBLEM LIST
PPDS-1 Ilmu Penyakit Dalam - Fakultas Kedokteran Universitas Lambung Mangkurat/ RSUD Ulin Banjarmasin
44. CUE AND CLUE Problem List
Diagnosis
Planning Diagnosis
Therapy monitoring
Mrs.T/ 56 yo
• Weaknesses, Looks pale
• Nausea and vomite, low intake
• Post chemotherapy 6 cycle dt adenocarcinoma gaster
• History of black vomiting and black stool continuously 2 weeks ago
• History of repeated hospitalization due to anemia and got
transfusion
1. Severe Anemia NN 1.1 Chronic
Blood loss
1.2 Chronic
disease
Benzidine test
Peripheral blood
smear
Reticulocyte
Non-pharmacology
O2 NC 3 lpm
Pharmacology
PRC transfusion:
(10 – 5.1) x 42 x 4 = 823 cc =
4bags PRC
Given 1 bag /12hours
+ Ca gluconas 1amp there after
Planning monitoring
- Weakness, signs of
O2 hunger, bleeding,
transfusion reaction
- Vital sign
- CBC evaluation after
transfusion
Planning education
- Complain might be
related to the
underlying
malignancy &
complication
(bleeding,
inadequate nutrition
intake)
- Report if there is
bleeding
manifestations
Physical examination
RR 20 bpm
SpO2 : 98 % on RA
Pale conjunctiva (+)
Abd: palpable mass (+) a/r right
hipocondriaca
RT: melena (-), blood (-)
Laboratory 18/10/23
Hb 5.1/MCV 95.3/ MCH 29.8
Eritrosit 1.71
RDW 15.7
EKG 18/10/23
Sinus rhytm, 98 bpm, LAE
Gastric biopsy 07/11/22:
Adenocarcinoma gaster
45. CUE AND CLUE Problem List Initial Diagnosis Planning Diagnosis
Therapy monitoring
Mrs.T/ 56 yo
• Nausea and vomite
• Decreased of appetite
• Adenocarcinoma gaster, post chemotherapy 6 cycle (cisplatin,5FU,
leucovorin), 3 months ago
2. Nausea vomite with
mild moderate
dehydration
2.1 related to
malignancy +
esofagitis
2.2 PUD
Endoscopy if needed Non-pharmacology
Drink water 1500cc/day
Pharmacology
Rehydration: 109/100x42 x30 =
1373.4 cc
Maintenance = 2000 cc
Total 3373.4 cc
IVFD Nacl 0.9%: 1500cc in the
1st 8hours, 1500cc in the next
16 hours
Maintenance IVFD Nacl 0.9%
1500cc/24h
IV:
- Omeprazole 40mg/24h
- Ondancentron 4 mg/8 h
PO:
Sucralfat syr 4x10 ml
Planning monitoring
- Nausea vomite, sign of
dehydration
- Fluid balance
- Urine output/day
- Vital sign
Planning education
- Complain might be
related to the
underlying malignancy
- Nutriton intake, small
portion and regularly
Physical examination
Pulse: 109 bpm post rehydration,
Pulse 96 bpm
UOP : 500 cc/24 hours
Diuresis : 0.4 cc/kgBB/hours
sunkend eye (+) dry turgor (+) dry lips
(+)
tenderness (+) a/r epigastric, mass (+)
a/r right hipocondriaca
WHO dehydration score = 8
Laboratory 18/10/23
Na 128/K 4.8/ Cl 104
Osm 267 (hipoosmolar)
Ur 45/ Cr 1.63
Endoscopy results 05/11/22
Esophagitis LA grade B
Mass curvatura minor corpus to
gastric antrum suspected malignant
Gastric biopsy 07/11/22:
Adenocarcinoma gaster
46. CUE AND CLUE Problem List Initial Diagnosis Planning Diagnosis
Planning
Therapy
Planning
monitoring
Mrs. T/56 yo
• Weaknesses
• Nausea and vomite
• Decreased appetite
• HT (-) DM (-)
3. AKI st 1 ec volume
depletion
Non-Farmakologi
- Avoid Nephrotoxic drug
- Drink water 1500cc/day
Pharmacology
Rehydration: 109/100x42 x30 = 1373.4
cc
Maintenance = 2000 cc
Total 3373.4 cc
IVFD Nacl 0.9%: 1500cc in the 1st
8hours, 1500cc in the next 16 hours
Maintenance IVFD Nacl 0.9% 1500 cc/
24h
Planning Monitoring :
- UO, Balance fluid
- Ur Cr 48 h
Planning Education
- Avoid dehydration
- Avoid nephrotoxic
drug
Phy. Exam:
BP : 110/80mmHg
Head: sunkend eye (+)
dry turgor (+) dry lips
(+)
Abd: tenderness (+) a/r
epigastric, mass (+) a/r
right hipocondriaca
UOP : 500 cc/24
hours
Diuresis : 0.4
cc/kgBB/hours
WHO dehydration
score = 8
Lab 18/10/23
Hb 5.1 MCV 95.3 MCH 29.8
Ur 45/ Cr 1.63 eGFR 37
BUN: Cr 12.9:1
Lab 9/9/23
Cr 1.21
Urinalysis 19/10/23
Yellow clear
pH 6.0, Spesific gravity 1.025
Prot +1
USG abdomen 2/8/23 after
chemotherapy
bilateral Kidney and Vesica
Urinaria within normal limits
INITIAL PLAN
47. CUE AND CLUE Problem List Initial Diagnosis Planning Diagnosis
Therapy monitoring
Mrs.T/ 56 yo
• Mass in the abdomen dextra and the middle of the stomach
• Decreased appetite
• Stomach felt full quickly
• Decrease of body weight
• Post chemotherapy 6 cycle (cisplatin,5FU, leucovorin)
• Diagnosed with tumor in the stomach based on endoscopy and the biopsy
result Adenocarcinoma gaster
4. Gastric
adenocarcinoma
stage IV post
chemotherapy
with cancer pain
And cancer
cachexia
Non-pharmacology
- Basal Callory x 25 = 1237 kkal
- Age (-10%), ill (+20%), activity
(+10%) = 1703 kcal /day
- Carbohydrate 60%= 1022 kcal/day =
255.5 g/day
- Protein 1gr/kg/day = 49 gr = 196
kcal/day
- Fat = 485 kcal/day = 53.8 g/day
Diet High Calorie High Protein 1703
kcal/day
Pharmacology
Tramadol 100mg in Nacl 0.9%
100cc/8 h
Consider consult HOM division for
restaging
Consult Nutrisionist in ward
Planning monitoring
- Diet/intake
- Ecog and karnofsky
score
- BW, mass
enlargement
- CBC, comprehensive
chemistry profile
- CT scan abdomen
contras
- HER 2, PD-L1
Planning education
- Staging is required to
allow planning of
definitive therapy
- Nutriton intake, small
portion and regularly
Physical examination
ECOG 2
Karnofsky 60
VAS 5
BW: 42 Kg / TB: 155cm/ IMT:
17.5 (Underweight)
Status lokalis a/r right
hipocondriaca:
palpable hard mass, diameter
7 cm, uneven surface, unclear
boundaries, mobile,
tenderness (+)
Laboratory 18/10/23
SGOT 70/ SGPT 37
Rontgen thorax 18/10/23 post chemotherapy
Opaque nodule with other small opaque
nodules around it 6th intercostal right posterior
soft tissue mass (enlargement)
CT scan abdoment Ulin Hospital 06/1/23
- gastric mass susp. malignancy
- multiple Hepar nodules suggestive of liver
metastases
- no visible KGB enlargement paraaourta
abdominalis
Gastric biopsy 07/11/22:
Adenocarcinoma gaster
USG abdomen 2/8/23 after chemotherapy
Normal limits
48. CUE AND CLUE Problem List Initial Diagnosis Planning Diagnosis
Therapy monitoring
Mrs.T/ 56 yo
• Nausea and vomite
• Decreased appetite
• Weight loss 60 Kg 42Kg in 7 month
• Dysphagia (-), odynophagia (-), heart burn (-)
5. Esofagitis
(LA gr B)
Non-pharmacology
Diet High Calorie High Protein 1703
kcal/day
Pharmacology
IV :
Omeprazole 40mg/24h
PO:
Sucralfat syr 4x10 ml
Planning monitoring
- Nausea, vomite
Planning education
- Nutrion intake small
portion and regularly
Physical examination
Abd: tenderness (+) a/r
epigastric,
Endoscopy results 05/11/22
Esophagitis LA grade B
Mass curvatura minor corpus to gastric
antrum suspected malignant
49. CUE AND CLUE Problem List Initial Diagnosis Planning Diagnosis
Therapy monitoring
Mrs.T/ 56 yo
• Weaknesses
• Nausea and vomite
• Decreased appetite
• Urination was decreased
6. Asymptomatic
moderate
hyponatremia
hypoosmolar
hypovolemia
6.1. Ekstra renal
loss
6.1.1 GI loss
6.1.2 Low intake
6.2 Renal loss
Sodium urine if
needed
Non-pharmacology
Drink water 1500cc/day
Pharmacology
Rehydration: 109/100x42 x30 =
1373.4 cc
Maintenance = 2000 cc
Total 3373.4 cc
IVFD NS 0.9%: 1500cc in the
1st 8hours, 1500cc in the next
16 hours
Maintenance IVFD Nacl 0.9%
1500 cc/24h
Planning monitoring
- Weakness, nausea and
vomite
- UO, fluid balance
- Vital signs, signs of
dehydration, SE
Planning education
- Balanced nutrition &
adequate fluid intake
Physical examination
Pulse: 109 bpm post
rehydration, Pulse 96 bpm
Head: sunkend eye (+) dry
turgor (+) dry lips (+)
UOP : 500 cc/24 hours
Diuresis : 0.4
cc/kgBB/hours
WHO dehydration score = 8
Laboratory 18/10/23
RBG 108
Na 128/K 4.8/ Cl 104
Osm 267 (hipoosmolar)
Gastric biopsy 07/11/22:
Adenocarcinoma gaster
CT scan abdoment Ulin Hospital 06/2/23
- gastric mass susp. malignancy
- multiple Hepar nodules suggestive of liver
metastases
- no visible KGB enlargement paraaourta
abdominalis
50.
51. No Date PROBLEM SOAP TTD PPDS TTD DPJP
1 19/10/23 Severe anemia NN Subjective:
Weakness +, melena -
Objective:
BP : 100/70mmHg
Pulse: 99x/menit
RR : 22x/menit
T : 36.3⁰C
SpO2 : 98 % on RA
Assessment:
Severe anemia NN
Therapy :
O2 NC 3 lpm
PRC transfusion:
(10 – 5.1) x 42 x 4 = 823 cc = 4bags PRC
Given 1 bag /12hours
+ Ca gluconas 1amp there after
Plans:
CBC evaluation after transfusion
Dr. Firdinia Dr. Yulia,SpPD
Progress Note
52. No Date PROBLEM SOAP TTD PPDS TTD DPJP
2. 19/10/23 Nausea vomite with mild
moderate dehydration
Subjective:
Nausea -, Vomite –
Objective:
BP : 100/70mmHg
Pulse: 99x/menit
RR : 22x/menit
T : 36.3⁰C
SpO2 : 98 % on RA
WHO dehydration score 6
Assessment:
Nausea vomite with mild moderate dehydration
Therapy :
Maintenance IVFD Nacl 0.9% 1500cc/24h
IV:
- Omeprazole 40mg/24h
- Ondancentron 4 mg/8 h
PO:
Sucralfat syr 4x10 ml
Plans:
- Monitoring sign of dehydration
Dr. Firdinia Dr. Yulia,SpPD
Progress Note
53. No Date PROBLEM SOAP TTD PPDS TTD DPJP
3 19/10/23 AKI st 1 ec volume depletion Subjective:
Weaknesses -, Nausea -, vomite -
Objective:
BP : 100/70mmHg
Pulse: 99x/menit
RR : 22x/menit
T : 36.3⁰C
SpO2 : 98 % on RA
UO
Assessment:
AKI st 1 ec volume depletion
Therapy :
Maintenance IVFD Nacl 0.9% 1500cc/24h
Plans:
- Fluid balance
- Urine output/day
Dr. Firdinia Dr. Yulia,SpPD
Progress Note
54. No Date PROBLEM SOAP TTD PPDS TTD DPJP
4 19/10/23 Gastric adenocarcinoma stage
IV post chemotherapy
(progression disease)
with cancer pain
And cancer cachexia
Subjective:
Epigastric pain decreased,
Feel full
Objective:
BP : 100/70mmHg
Pulse: 99x/menit
RR : 22x/menit
T : 36.3⁰C
SpO2 : 98 % on RA
Assessment:
Gastric adenocarcinoma stage IV post chemotherapy
(progression disease)
with cancer pain
And cancer cachexia
Therapy :
Diet High Calorie High Protein 1703 kcal/day
Pharmacology
Tramadol 100mg in Nacl 0.9%
100cc/8 h
Plan:
Evaluasion Ecog and karnofsky score
CT scan abdomen contras
Check HER 2
Dr. Firdinia Dr. Yulia,SpPD
Progress Note
55. No Date PROBLEM SOAP TTD PPDS TTD DPJP
5 19/10/23 Esophagitis
(LA gr B)
Subjective:
Nausea -, vomite –
Objective:
BP : 100/70mmHg
Pulse: 99x/menit
RR : 22x/menit
T : 36.3⁰C
SpO2 : 98 % on RA
Assessment:
Esophagitis (LA gr B)
Therapy :
IV :
Omeprazole 40mg/24h
PO:
Sucralfat syr 4x10 ml
Dr. Firdinia Dr. Yulia,SpPD
Progress Note
56. No Date PROBLEM SOAP TTD PPDS TTD DPJP
6. 19/10/23 Asymptomatic moderate
hyponatremia hypoosmolar
hypovolemia
Subjective:
Nausea -, vomite –
Objective:
BP : 100/70mmHg
Pulse: 99x/menit
RR : 22x/menit
T : 36.3⁰C
SpO2 : 98 % on RA
UO : 300cc/9 h
Diur: 0.8 cc/kg/h
Assessment:
AKI st 1 ec volume depletion
Therapy :
Maintenance IVFD Nacl 0.9% 1500 cc/24h
Plans
- Fluid balance
- Urine output/day
Dr. Firdinia Dr. Yulia,SpPD
Progress Note
57. THEORY AND GUIDELINE
PPDS-1 Ilmu Penyakit Dalam - Fakultas Kedokteran Universitas Lambung Mangkurat/ RSUD Ulin Banjarmasin